Shrimali Raj Kumar, Nallathambi Chandran, Saha Animesh, Das Avipsa, Prasath Sriram, Mahata Anurupa, Arun B, Mallick Indranil, Achari Rimpa, Dabkara Deepak, Thambudorai Robin, Chatterjee Sanjoy
Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India.
Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India.
Indian J Cancer. 2018 Apr-Jun;55(2):125-133. doi: 10.4103/ijc.IJC_469_17.
Radical radiotherapy (RT) with curative intent, with or without chemotherapy, is the standard treatment for inoperable, locally advanced nonsmall cell lung cancer (NSCLC).
We retrospectively reviewed the data for all 288 patients who presented with inoperable, locally advanced NSCLC at our institution, between May 2011 and December 2016.
RT alone or sequential chemoradiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) was used for 213 patients. Median age was 64 years (range: 27-88 years). Stage-III was the biggest stage group with 189 (88.7%) patients. Most patients with performance status (PS) 0 or 1 received CCRT, whereas most patients with PS 2 received RT alone (P < 0.001). CCRT, SCRT, and RT alone were used for 120 (56.3%), 24 (11.3%), and 69 (32.4%) patients, respectively. A third of all patients (32.4%) required either volumetric-modulated arc radiotherapy (VMAT) or tomotherapy. Median follow-up was 16 months. The median progression-free survival and median overall survival (OS) were 11 and 20 months, respectively. One-year OS and 2-year OS were 67.9% and 40.7%, respectively. Patients treated using CCRT lived significantly longer with a median survival of 28 months, compared with 13 months using SCRT and RT alone (P < 0.001). On multivariate analysis, OS was significantly affected by age, stage group, treatment approach, and response to treatment.
RT including CCRT is feasible, safe, and well tolerated in our patient population and results in survival benefits comparable with published literature. CCRT should be considered for all patients with inoperable, locally advanced NSCLC, who are fit and have good PS.
根治性放疗（RT），无论是否联合化疗，都是无法手术的局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。
我们回顾性分析了2011年5月至2016年12月期间在我院就诊的所有288例无法手术的局部晚期NSCLC患者的数据。
213例患者接受了单纯放疗或序贯放化疗（SCRT）或同步放化疗（CCRT）。中位年龄为64岁（范围：27 - 88岁）。Ⅲ期是最大的分期组，有189例（88.7%）患者。大多数体能状态（PS）为0或1的患者接受CCRT，而大多数PS为2的患者接受单纯放疗（P < 0.001）。CCRT、SCRT和单纯放疗分别用于120例（56.3%）、24例（11.3%）和69例（32.4%）患者。所有患者中有三分之一（32.4%）需要容积调强弧形放疗（VMAT）或断层放疗。中位随访时间为16个月。中位无进展生存期和中位总生存期（OS）分别为11个月和20个月。1年总生存率和2年总生存率分别为67.9%和40.7%。与SCRT和单纯放疗的13个月相比，接受CCRT治疗的患者生存时间显著更长，中位生存期为28个月（P < 0.001）。多因素分析显示，总生存期受年龄、分期组、治疗方法和治疗反应的显著影响。
包括CCRT在内的放疗在我们的患者群体中是可行、安全且耐受性良好的，并且生存获益与已发表的文献相当。对于所有无法手术的局部晚期NSCLC患者，只要身体状况良好且PS评分高，都应考虑CCRT。
